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Small intestinal function and dietary status in dermatitis herpetiformis.

D J Gawkrodger¹, C McDonald, S O'Mahony

¹Department of Dermatology, Royal Infirmary, Edinburgh.

|April 1, 1991

Summary

Dermatitis herpetiformis patients often have small intestine abnormalities. A gluten-free diet can normalize intestinal histology, but some patients remain abnormal despite normal biopsies.

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Published on: December 3, 2020

Area of Science:

Gastroenterology
Dermatology
Immunology

Background:

Dermatitis herpetiformis (DH) is an autoimmune blistering skin condition.
DH is strongly associated with celiac disease and small intestinal enteropathy.
The impact of diet on intestinal morphology and function in DH requires further investigation.

Purpose of the Study:

To assess small intestinal morphology and function in patients with dermatitis herpetiformis.
To evaluate the effect of a gluten-free diet on intestinal abnormalities in DH.
To identify reliable diagnostic markers for enteropathy in DH.

Main Methods:

Histopathological evaluation of jejunal mucosal biopsy specimens.
Quantitation of intraepithelial lymphocytes.
Cellobiose/mannitol permeability test, tissue disaccharidase values, and serum antigliadin antibodies.
Formal assessment of dietary gluten content by a dietician.

Main Results:

A gluten-free diet normalized jejunal biopsy specimens in most patients.
No correlation was found between gluten intake and enteropathy severity in patients on a normal diet.
Intestinal permeability and antigliadin antibodies were abnormal in most patients with enteropathy.
A subset of patients had normal intestinal investigations despite DH.

Conclusions:

Objective tests of small intestinal architecture and function detect abnormalities in most DH patients.
A gluten-free diet is crucial for improving intestinal health in DH.
A small group of DH patients exhibit normal intestinal findings despite the condition.